93295
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.72
Facility
$36.07
Non-Facility
$36.07
Documentation Required
- The patient's medical record must document relevant medical history, physical exam, and results of pertinent diagnostic tests or procedures supporting medical necessity for the interrogation service.
- Maintain date(s) of device implant, device identification, a copy of the physician's order for the service, all transmissions, formal interpretations/reports, and the reason for the service (routine follow-up versus specific symptoms).
- If the service is for symptoms, document the nature of the symptoms; if Internet-based remote service is used, retain a signed service agreement between manufacturer and physician if required.
- The interpreting physician must personally review/analyze device data, generate and sign the report when billing the professional component; when the technical component is billed separately, documentation of supervision/interpretation is required.
Key Coverage Criteria
- Face-to-face interrogation is covered each time it is medically necessary and provided with documentation of medical necessity.
- Remote interrogation is covered as a surveillance option beginning with initiation of remote monitoring or starting on the 91st day after ICD implantation.
- ICD surveillance (face-to-face or remote) is covered to monitor device behavior or to investigate symptoms such as post-event shock, syncope/near-syncope, palpitations, suspected malfunction, or device failure.
- Routine surveillance interrogation is covered for asymptomatic patients without device discharge (monitoring purpose), e.g., presence of ICD Z95.810.
- Interrogation and reprogramming are covered to evaluate and adjust device settings including iterative testing to select optimal programmed parameters.
- Peri-procedural evaluation/interrogation and programming before and/or after a surgical procedure or test is covered when necessary to modify or disable device function for the procedure (e.g., to avoid electrocautery interference or disable during cardiac surgery).
13 Active Policies
A53018 — Billing and Coding: Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based
J06
L33693 — Peripheral Venous Ultrasound
J09
L34833 — Cardiac Rhythm Device Evaluation
J12
L37371 — Electroretinography (ERG)
J12
Related Codes
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